I welcome comments and feedback from readers who follow our blog and use myLifeSite tools. These responses provide important insights about choosing senior living options. Recently, a reader emailed me saying she and her husband are set on moving to a continuing care retirement community (CCRC, also called a life plan community) in the coming years but voiced a concern I’ve heard before.
She wrote that, although she feels confident their plan will ensure they receive the care they need for life, she still fears “…that ‘they’ will move me or my husband into assisted living or skilled nursing care too soon. It is similar to the fear people have of being put in a ‘home’ too soon, say, by their kids.”
Her email told the story of a friend’s mother who lived in a CCRC in the southeast and, after a broken hip, was moved into the community’s skilled nursing facility. Following rehab, the community determined she could not safely return to independent living. The woman and her family disagreed and fought to have her return to her apartment with supports.
This example highlights a common worry about who ultimately decides whether a resident can live independently. That concern is understandable, so let’s examine how decisions are typically made and whether those fears are warranted.
An innate desire for independence
From early childhood onward, people naturally want to make their own choices and live independently. That desire explains why a large majority of older adults—about 90 percent, according to AARP—intend to remain in their own homes as they age.
>> Related: Is “Aging Independently” a Myth?
Many assume that moving to a CCRC means losing independence. In fact, for many residents, CCRCs help preserve independence longer through wellness programs, social opportunities, community engagement, and on-site support services. Still, as the reader’s story shows, differences of opinion can arise between a community and a resident or family about someone’s ability to live alone.
The final say in determining care needs
Most CCRCs emphasize keeping residents in independent living as long as it is safe and practical. A CCRC representative I contacted explained, “We try to bring services to the resident (in-home care, medication management, etc.) for as long as it remains practical and safe because we know they will thrive in their own environment.”
Typical CCRC practice is to consult with the resident, family, and medical professionals and take a holistic approach to determine care needs. Residency contracts commonly include language stating that when evaluating whether a resident needs a higher level of care, the community will consult the resident, family, personal representative, and attending physician, but the community’s decision is binding.
Ultimately, decisions are guided by the health and safety of the resident and others. Safety concerns may include physical risks—such as being unable to evacuate in an emergency—or cognitive decline that makes living alone unsafe.
Sometimes family members or the resident are in denial about the person’s ability to live independently. A well-known legal case involved a judge siding with a CCRC that required a wheelchair-bound resident with dementia to move to a higher level of care despite her wish to stay in her independent living apartment.
From a family’s perspective, hoping a loved one can remain independent is natural. Still, professionals may assess risks differently. As in the example of the woman recovering from a hip fracture and the legal case cited above, opinions can differ, but communities generally have the authority to determine whether a resident can live safely on their own.
>> Related: Who Decides if a CCRC Resident Needs a Higher Level of Care?
Easing concerns about progressive care
Julie Davis, a marketing director at a CCRC in Oklahoma City, shared a practical perspective that may ease fears about being moved to higher care prematurely. Some worry that a facility might move a resident to higher care to free up an independent living unit and collect a new entry fee. Julie pointed out that this logic is flawed.
“For us, it’s more expensive for the community to provide services for someone at a higher level of care, so it would not make good business sense to encourage a resident to move prematurely,” she said. Moving residents internally also carries costs: refurbishing the vacated apartment takes time and money. Many communities prefer full independent living occupancy and a wait list rather than moving someone unnecessarily.
Care tailored to residents’ needs
When deciding how to provide care, CCRCs consider state regulations, their residency contract policies, and residents’ financial resources. Some communities focus on supporting residents to remain safely in independent living with in-home services, while others may require a permanent transfer to assisted living for certain long-term care needs.
Although disagreements between residents, families, and communities sometimes occur, CCRCs use a range of approaches to provide an appropriate level of assistance along the continuum of care. That typically includes involving the resident, family, and medical team in housing and care decisions.
If you are considering a move to a CCRC, use available tools to explore options and learn how different communities approach progressive care and resident autonomy.